Comparative Clinical Outcomes of Irrigation Techniques in Burr-hole Craniostomy for Chronic Subdural Hemorrhage: a Multicenter Cohort Study

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2024 Jul 1

PMID 38951156

Authors

Ho Seong Cho

Hyun-Seok Lee

Yoo Sung Jeon

Won Hee Lee

Kyung Rae Cho

Affiliations

Soon will be listed here.

Abstract

Background: Chronic Subdural Hemorrhage(cSDH) is often treated with surgical blood drainage, but concerns about recurrence and outcomes persist. Surgical techniques, including irrigation, vary. This study compares the outcomes of irrigation in cSDH surgery.

Materials And Methods: From September 2020 to September 2022, 92 cSDH patients underwent surgery. Two different irrigation methods were used: extensive irrigation (IG) and non-irrigation (NIG). Method of irrigation was selected by each surgeon's preference. Parameters measured included volume of hematoma changes, midline shifting, complications, and basic demographics. Recurrence was defined as symptomatic or hematoma expansion more than double the volume before surgery. Factors predicting recurrence and irrigation method impact were analyzed.

Results: Eleven patients were excluded because of bilateral or related to other disease. We analyzed 81 patients (44 NIG, 37 IG). Recurrence occurred in 6 IG cases (16.2%) and 1 NIG case (2.3%). Irrigation method significantly affected recurrence (P = 0.043). Age, gender, medication, medical history, and preoperative measurements had no major impact on recurrence. NIG had unexpected cases of intracerebral hemorrhage.

Conclusion: Extensive irrigation may increase recurrence in cSDH drainage. Non-irrigation drainage had fewer recurrences, but unexpected complications arose. Careful drainage in non-irrigated cases is crucial.

References

Almenawer S, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B . Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg. 2013; 259(3):449-57. DOI: 10.1097/SLA.0000000000000255. View

An S, Kim T, Yoon B . Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017; 19(1):3-10. PMC: 5307940. DOI: 10.5853/jos.2016.00864. View

Choi J, Pyen J, Cho S, Kim J, Koo Y, Whang K . Influence of Antithrombotic Medication on the Risk of Chronic Subdural Hematoma Recurrence after Burr-Hole Surgery. J Korean Neurosurg Soc. 2020; 63(4):513-518. PMC: 7365285. DOI: 10.3340/jkns.2019.0194. View

De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A . Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One. 2013; 8(7):e68732. PMC: 3709887. DOI: 10.1371/journal.pone.0068732. View

Feghali J, Yang W, Huang J . Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome. World Neurosurg. 2020; 141:339-345. DOI: 10.1016/j.wneu.2020.06.140. View

Guo X, Wu L, Ou Y, Yu X, Zhu B, Yang C . Postoperative pneumocephalus and recurrence and outcome of chronic subdural hematoma: a systematic review and meta-analysis. Neurosurg Rev. 2022; 46(1):13. DOI: 10.1007/s10143-022-01925-x. View

Iftikhar M, Siddiqui U, Rauf M, Malik A, Javed G . Comparison of Irrigation versus No Irrigation during Burr Hole Evacuation of Chronic Subdural Hematoma. J Neurol Surg A Cent Eur Neurosurg. 2016; 77(5):416-21. DOI: 10.1055/s-0035-1564049. View

Kamenova M, Lutz K, Schaedelin S, Fandino J, Mariani L, Soleman J . Does Early Resumption of Low-Dose Aspirin After Evacuation of Chronic Subdural Hematoma With Burr-Hole Drainage Lead to Higher Recurrence Rates?. Neurosurgery. 2016; 79(5):715-721. DOI: 10.1227/NEU.0000000000001393. View

Kolias A, Chari A, Santarius T, Hutchinson P . Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014; 10(10):570-8. DOI: 10.1038/nrneurol.2014.163. View

10.

Krupp W, Jans P . Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage. Br J Neurosurg. 1995; 9(5):619-27. DOI: 10.1080/02688699550040909. View

11.

Kuroki T, KATSUME M, Harada N, Yamazaki T, Aoki K, Takasu N . Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir (Wien). 2001; 143(10):1041-4. DOI: 10.1007/s007010170010. View

12.

Liu W, Bakker N, Groen R . Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014; 121(3):665-73. DOI: 10.3171/2014.5.JNS132715. View

13.

Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N . Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. Neurol Res. 1999; 21(3):277-80. DOI: 10.1080/01616412.1999.11740931. View

14.

Miah I, Tank Y, Rosendaal F, Peul W, Dammers R, Lingsma H . Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis. Neuroradiology. 2020; 63(1):27-40. PMC: 7803717. DOI: 10.1007/s00234-020-02558-x. View

15.

Miah I, Holl D, Blaauw J, Lingsma H, den Hertog H, Jacobs B . Dexamethasone versus Surgery for Chronic Subdural Hematoma. N Engl J Med. 2023; 388(24):2230-2240. DOI: 10.1056/NEJMoa2216767. View

16.

Neidert M, Schmidt T, Mitova T, Fierstra J, Bellut D, Regli L . Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma: Associations with initial presentation and clinical outcome. J Clin Neurosci. 2016; 28:82-6. DOI: 10.1016/j.jocn.2015.09.022. View

17.

Poulsen F, Munthe S, Soe M, Halle B . Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery: a randomized trial. Clin Neurol Neurosurg. 2014; 123:4-8. DOI: 10.1016/j.clineuro.2014.05.003. View

18.

Rauhala M, Luoto T, Huhtala H, Iverson G, Niskakangas T, Ohman J . The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg. 2019; 132(4):1147-1157. DOI: 10.3171/2018.12.JNS183035. View

19.

Shen J, Yuan L, Ge R, Wang Q, Zhou W, Jiang X . Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study. Injury. 2019; 50(10):1634-1640. DOI: 10.1016/j.injury.2019.08.019. View

20.

Shimizu Y, Park C, Tokuda K . Gradation density hematoma is a predictor of chronic subdural hematoma recurrence associated with inflammation of the outer membrane. Clin Neurol Neurosurg. 2020; 194:105839. DOI: 10.1016/j.clineuro.2020.105839. View